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New and improved techniques have been continuously introduced into CT and MR imaging modalities for the diagnosis and therapy planning of acute stroke. Nevertheless, non-contrast CT (NCCT) is almost always used by every institution as the front line diagnostic imaging modality due to its high affordability and availability. Consequently, the potential reward of extracting as much clinical information as possible from NCCT images can be very great. Intravenous tissue plasminogen activator (tPA) has become the gold standard for treating acute ischemic stroke because it is the only acute stroke intervention approved by the FDA. ASPECTS scoring based on NCCT images has been shown to be a reliable scoring method that helps physicians to make sound decisions regarding tPA administration. In order to further reduce inter-observer variation, we have developed the first end-to-end automatic ASPECTS scoring system using a novel method of contralateral comparison. Due to the self-adaptive nature of the method, our system is robust and has good generalizability. ROC analysis based on evaluation of 103 subjects who presented to the stroke center of Chang Gung Memorial Hospital with symptoms of acute stroke has shown that our system’s dichromatic classification of patients into thrombolysis indicated or thrombolysis contraindicated groups has achieved a high accuracy rate with AUC equal to 90.2 %. The average processing time for a single case is 170 s. In conclusion, our system has the potential of enhancing quality of care and providing clinical support in the setting of a busy stroke or emergency center.

Aim To evaluate the utility of the portal venous phase on multiphasic computed tomography (CT) after treatment of hepatocellular carcinoma (HCC) with trans-arterial chemoembolisation (TACE). Materials and methods This was a retrospective review of patients who underwent TACE for HCC between 1 April 2012 and 21 December 2014, with appropriate multiphasic, pre- and post-procedural CT examinations. The maximum non-contrast, arterial phase, and portal venous phase attenuation values of the tumour and tumour bed were evaluated within a region of interest (ROI), with values adjusted against background hepatic parenchyma. Linear regression analyses were performed for both the arterial and venous phases, to assess the level of enhancement and to determine if the venous phase had additional value in this setting. Results A total of 86 cases from 51 patients were reviewed. All pre-procedural CT examinations of lesions demonstrated arterial phase enhancement with portal venous and delayed phase washout compatible with HCC. The post-procedural CT examinations following TACE revealed expected decreased arterial enhancement. Sixty-five cases (76%) showed persistent non-enhancement on the portal venous phase following embolisation therapy. A total of 21 cases (24%), however, demonstrated progressive portal venous hyper enhancement. Linear regression analysis demonstrated a statistical significance between the difference in maximal arterial and portal venous enhancement in these cases. Conclusion Following TACE, the treated lesion may demonstrate portal venous phase hyper-enhancement within the tumour bed. As such, full attention should be given to these images for comprehensive evaluation of tumour response following treatment.

A 45-year-old, premenopausal black woman (gravida 3, para 2, with a history of one spontaneous abortion) presents with menorrhagia and dysmenorrhea that has worsened progressively over a period of 10 years. She does not wish to have any more children. On physical examination, she has a firm, nontender, enlarged uterus. The ovaries are not palpable. Laboratory tests in the past had revealed intermittent mild anemia that was correctable with iron supplementation, but more severe anemia has been noted recently, and she has had increasing difficulty managing her menstrual bleeding. In-office ultrasound examinations have shown several intramural uterine masses consistent with uterine fibroids that have been slowly increasing in size; the largest measures 6.5 cm at the point ofits greatest dimension. The adnexa are normal. The patient's gynecologist has recommended a hysterectomy. However, the patient does not want to undergo a hysterectomy, and her gynecologist suggests uterine fibroid embolization as an alternative. She is referred to an interventional radiologist who orders a magnetic resonance imaging (MRI) scan. The results ofthe MRI confirm the ultrasound findings and rule out adenomyosis. The interventional radiologist discusses with the patient uterine fibroid embolization as an alternative to hysterectomy. What treatment should be recommended for this patient?

R. Torrance Andrews, MD, James B. Spies, MD, David Sacks, MD, Robert L. Worthington-Kirsch, MD, Gerald A. Niedzwiecki, MD, M. Victoria Marx, MD, David M. Hovsepian, MD, Donald L. Miller, MD, Gary P. Siskin, MD, Rodney D. Raabe, MD, Scott C. Goodwin, MD, Robert J. Min, MD, Joseph Bonn, MD, John F. Cardella, MD, and Nilesh H. Patel, MD, for the Task Force on Uterine Artery Embolization and the Standards Division of the Society of Interventional Radiology

To assess long-term clinical outcomes of uterine artery embolization across a wide variety of practice settings in a large patient cohort.The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization was a 3-year, single-arm, prospective, multi-center longitudinal study of the short- and long-term outcomes of uterine artery embolization for leiomyomata. Two thousand one hundred twelve patients with symptomatic leiomyomata were eligible for long-term follow-up at 27 sites representing a geographically diverse set of practices, including academic centers, community hospitals, and closed-panel health maintenance organizations. At 36 months after treatment, 1,916 patients remained in the study, and of these, 1,278 patients completed the survey. The primary measures of outcome were the symptom and health-related quality-of-life scores from the Uterine Fibroid Symptom and Quality of Life questionnaire.Mean symptom scores improved 41.41 points (P.001), and the quality of life scores improved 41.47 points (P.001), both moving into the normal range for this questionnaire. The improvements were independent of practice setting. During the 3 years of the study, Kaplan-Meier estimates of hysterectomy, myomectomy, or repeat uterine artery embolization were 9.79%, 2.82%, and 1.83% of the patients, respectively.Uterine artery embolization results in a durable improvement in quality of life. These results are achievable when the procedure is performed in any experienced community or academic interventional radiology practice.III.

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.

Arteriovenous fistulae and grafts for hemodialysis access are a lifeline in patients with end-stage renal disease. A significant cause of morbidity and mortality in this population is dialysis access dysfunction. Duplex ultrasound imaging is an excellent modality to evaluate arteriovenous fistulae and grafts, the 2 main types of long-term hemodialysis access. This review provides a detailed Doppler ultrasound protocol for evaluation of fistulae or grafts to familiarize imagers with their normal appearance, highlighting common dialysis access complications.

Objective To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. Design Prospective cohort controlled study. Setting Sixteen medical centers in the United States. Patient(s) One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. Intervention(s) Myomectomy or UAE. Main Outcome Measure(s) Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. Result(s) Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. Conclusion(s) The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

OBJECTIVES: To investigate the change in symptom severity and health-related quality of life among patients treated with uterine artery embolization for leiomyomata. METHODS: Using the Fibroid Registry for Outcomes Data (FIBROID), a multicenter, prospective, voluntary registry of patients undergoing uterine embolization for leiomyomata, we studied changes in symptom status, health-related quality of life, subsequent care, menstrual status, and satisfaction with outcome. Health-related quality-of-life and symptom status were measured using the Uterine Fibroid Symptom and Quality of Life, a leiomyoma-specific questionnaire. Summary statistics were used to describe the data set and multivariate analyses to determine predictors of outcome at 12 months. RESULTS: Of 2,112 eligible patients, follow-up data were obtained on 1,797 (85.1%) at 6 months and 1,701 (80.5%) at 12 months. At 12 months, the mean symptom score had improved from 58.61 to 19.23 (P < .001), whereas 5.47% of patients had no improvement. The mean health-related quality-of-life score improved from 46.95 to 86.68 (P < .001), whereas 5.0% did not improve. In the first year after embolization, hysterectomy was performed in 2.9% of patients, with 3.6% requiring gynecologic interventions by 6 months and an additional 5.9% between 6 and 12 months. Amenorrhea as a result of embolization occurred in 7.3% of patients. Of these, 86% were age 45 or older. Most patients were satisfied with their outcome (82% strongly agree or agree). Predictors of a greater symptom change score include smaller leiomyoma size, submucosal location, and presenting symptom of heavy menstrual bleeding. CONCLUSION: Uterine embolization results in substantial symptom improvement for most patients, with hysterectomy required in only 2.9% of patients in the first 12 months after therapy.

Scott C. Goodwin, MD, Sheila C. Bonilla, MD, David Sacks, MD, Richard A. Reed, MD, James B. Spies, MD,Wendy J. Landow, MPH, Robert L. Worthington-Kirsch, MD, the Members of the Reporting Standards forUterine Artery Embolization (UAE) Subcommittee, the Members of the UAE Task Force StandardsSubcommittee, and the Members of the Society of Interventional Radiology Technology Assessment Committee

The feasibility of using magnetic targeted carriers (MTC) to deliver doxorubicin intravesically was studied in normal swine bladder. MTCs are microparticles consisting of metallic iron and activated carbon. Doxorubicin is adsorbed to the activated carbon component of the MTCs (MTC-DOX) while the iron component provides magnetic susceptibility. This technology is designed for site-specific delivery of a drug to a tumor in the presence of an externally applied magnetic field in order to achieve prolonged release of high localized drug concentrations by retention of MTCs in the region of interest. An intravesical route of administration was evaluated as intravesical chemotherapy is used in the treatment of bladder cancer. The urethras of six swine were catheterized and Foley catheters were placed in their bladders. The effects of doses ranging from 10 to 80 mg doxorubicin adsorbed onto 300 to 800 mg MTCs were studied. A 30-min period of magnetic targeting immediately followed dosing, in which an external magnet was placed on the skin surface over a predetermined site on the bladder. The subsequent retention and distribution of test material was evaluated by measurement of doxorubicin levels in plasma and histopathological examination of the bladder following treatment. Blood samples were taken prior to treatment and at 15 and 30 min after infusion for measurement of doxorubicin. The bladder was drained and rinsed thoroughly following the procedure. Plasma doxorubicin concentrations were less than the assay limit of detection (10 ng/ml) during the 30 min following dosing. MTCs were found within the bladder walls, predominantly at the targeted site where they were present at greater depths within the layers of the epithelium. The study results show that MTC-DOX can be targeted and retained within specific locations in the bladder using magnetic targeting. MTC delivery may allow greater exposure and specific deposition of drug at a defined site over intravesical administration of doxorubicin alone. The feasibility of this novel method of drug delivery was demonstrated and the results support further study for its potential use in treating bladder cancer.

OBJECTIVE: To compare long-term outcomes of uterine artery embolization and abdominal myomectomy in patients with symptomatic uterine myomas. METHODS: At a single institution in an 18-month time, 59 patients had bilateral uterine artery embolization and 38 patients had abdominal myomectomy to treat symptomatic uterine myomas. We reviewed medical records and surveyed patients 3 or more years after their procedures to assess how many needed further surgical procedures in the intervening years, to what extent symptoms remained improved, and how satisfied the patients were with the long term results of the index procedure. RESULTS: Follow-up was available on 51 embolization and 30 myomectomy patients and ranged from 37 to 59 months. Patients who had embolization were older (44 versus 38 years, P < .001) and more likely to have had previous surgical procedures (P < .001) than those who had myomectomy. Taking into account the variable follow-up period, embolization patients were more likely to have had further invasive treatment for myomas (29% versus 3%) (P = .004). Among women not needing further surgery, overall symptoms improved in 92% (33/36) of embolization and 90% (26/29) of myomectomy patients (P = .78). Ninety-four percent (34/36) of embolization patients and 79% (23/29) of myomectomy patients were at least somewhat satisfied with their choice of procedure (P = .06). CONCLUSION: Women who had embolization were more likely than those who had myomectomy to need further invasive treatment (surgery or repeat embolization) in the 3–5 years after the index procedure. Among women who did not need such treatment, satisfaction and relief of symptoms were similar. Large, randomized trials are needed to more accurately compare these two procedures.

Building a uterine fibroid embolization (UFE) practice can be a complex process. Choices must be made regarding whether to align oneself with a gynecologist or to accept direct referrals. For the interventional radiologist, the responsibilities of evaluation and patient care pose unique and time-consuming administrative and clinical challenges. Physician extenders, either nurse practitioners or physician's assistants, play key roles as clinical coordinators by guiding the patient through the medical system and making certain that she is cleared for the procedure medically and logistically. In some settings, they may also assist in many of the technical aspects of the procedure and postoperative care. Interventional radiologists must be prepared for battles with insurance companies and be willing to go through the appeals process. Business officers must also be trained to properly code for the procedures to insure optimal reimbursement. The success of building a UFE practice may also be bolstered by directly marketing to patients and by providing them with access via the Internet. Copyright 2002, Elsevier Science (USA). All rights reserved.

Fortunately, the number of complications reported after uterine fibroid embolization (UFE) is extremely low. Angiographic mishap or drug reaction are probably more common than purely UFE-related complications. However, the possibility of infection or necrosis of the uterus, with their significant attendant morbidity, is a sobering reminder that embolotherapy can have a powerful impact on the target organ(s). Knowledge of the expected time course for symptom resolution and the often confusing imaging findings shortly after UFE are critical for avoiding unnecessary delay in surgical intervention or, perhaps more important, an inappropriate rush to surgery when antibiotics alone will suffice. Other complications include alteration of uterine physiology, which may disrupt sexual function, and menstrual irregularity and even premature menopause.

Increasing clinical experience with uterine fibroid embolization (UFE) has improved the ability of interventionalist radiologists to discern who is and who is not an appropriate candidate for this procedure. Initial evaluation should be directed at obtaining answers to the following key questions: (1) Does the patient have uterine fibroids that account for her symptoms and are they severe enough to require invasive treatment? (2) Does she desire future childbearing? (3) Are there any clinical indications or imaging signs of uterine malignancy? (4) Are there any medical or anatomic features that would favor a particular therapeutic modality? (5) What are her own preferences regarding treatment? Ultrasound and magnetic resonance imaging are vital elements to the assessment and planning of the appropriate course of action. Given the lack of prospective comparative trials between UFE and surgical treatment, recommendations are often highly influenced by patient preference.

We recently demonstrated that cancer cells that recover from damage exhibit increased aerobic glycolysis, however, the molecular mechanism by which cancer cells survive the damage and show increased aerobic glycolysis remains unknown. Here, we demonstrate that diverse cancer cells that survive hypoxic or oxidative damage show rapid cell proliferation, and develop tolerance to damage associated with increased production of hydrogen sulfide (H2S) which drives up-regulation of nicotinamide phosphoribosyltransferase (Nampt). Consistent with existence of a H2S-Nampt energetic circuit, in damage recovered cancer cells, H2S, Nampt and ATP production exhibit a significant correlation. Moreover, the treatment of cancer cells with H2S donor, NaHS, coordinately increases Nampt and ATP levels, and protects cells from drug induced damage. Inhibition of cystathionine beta synthase (CBS) or cystathionase (CTH), enzymes which drive generation of H2S, decreases Nampt production while suppression of Nampt pathway by FK866, decreases H2S and ATP levels. Damage recovered cells isolated from tumors grown subcutaneously in athymic mice also show increased production of H2S, Nampt and ATP levels, associated with increased glycolysis and rapid proliferation. Together, these data show that upon recovery from potential lethal damage, H2S-Nampt directs energy expenditure and aerobic glycolysis in cancer cells, leads to their exponential growth, and causes a high degree of tolerance to damage. Identification of H2S-Nampt as a pathway responsible for induction of damage tolerance in cancer cells may underlie resistance to therapy and offers the opportunity to target this pathway as a means in treatment of cancer.

Objective: This paper seeks to evaluate the ability to deliver term pregnancies following uterine fibroid embolization, and to identify impediments to pregnancy in the embolization procedure. Study design: Four physicians performed embolization procedures at various facilities. Patients were asked if fertility was an issue prior to embolization. We measured follicle-stimulating hormone levels before and after embolization. Clinical follow-up, six months following embolization was obtained by interview. Patients were questioned regarding attempts to conceive, menstrual history, and subsequent pregnancy. Main outcome measures: Complications were calculated upon the entire patient population, whether or not fertility was identified as a goal. Fertility risks from embolization were identified. We measured radiation exposure in a random consecutive group of 50 women undergoing embolization. All patients who conceived were asked the details of the pregnancy. Results: Four hundred women underwent uterine fibroid embolization between 1996 and 1999. One hundred and thirty nine patients stated a desire for fertility after embolization. Of these, 52 were

The toxicity of a single hepatic intra-arterial administration of doxorubicin (DOX) coupled to a magnetically targeted drug carrier (MTC) was evaluated in a swine model. MTC is a microparticle composite of elemental iron and activated carbon. MTC-DOX is a new formulation of doxorubicin absorbed to the MTC and is designed for site-specific delivery to a solid tumor in the presence of an externally applied magnetic field. The magnetic field induces extravasation of MTCs through the vascular wall, leading to localization and retention in the tissue at the targeted site. Eighteen swine were assigned to 6 treatment groups, including 3 control groups (vehicle control, doxorubicin, MTC), and 3 experimental groups that received the MTC-DOX preparation. Animals were given a single administration of test article, evaluated over 28 days, and then sacrificed. Signs of toxicity were monitored via clinical status, total body weight, gross and microscopic pathology, and serum chemistries. Angiography was used to determine the extent of any embolization present. There were no adverse effects observed in the DOX-alone group. Biologically significant, treatment-related gross and microscopic lesions were limited to the targeted area of the liver only in groups receiving > or =75 mg of MTC (with or without doxorubicin). The severity of liver necrosis correlated to the severity of embolization following treatment. Doxorubicin was not freely circulating in any of the MTC-DOX groups, suggesting successful localization to the targeted site. The no-adverse-effect level (NOAEL) was determined to be the MTC-DOX low-dose group.

To evaluate the safety and efficacy of a hydrodynamic thrombectomy system in a prospective, multicenter randomized comparison with pulse-spray thrombolysis in hemodialysis grafts.Nine centers enrolled 120 adult patients with recently (/=14 days) thrombosed hemodialysis grafts. Graft venography was used to confirm occlusion in 62 patients randomly assigned to thrombectomy and 58 to thrombolysis. For thrombolysis, a mixture of 5,000 U of heparin and 250,000 U of urokinase was distributed throughout the thrombus, first to the venous then to the arterial graft end. For thrombectomy, the catheter was passed in the same sequence. Technical success was removal of 80% or more of thrombus. Clinical success was technical success plus the ability to dialyze. Also assessed were total procedure time, thrombus treatment time, procedure-related blood loss, other complications, and 30- and 90-day outcomes.Patient demographics were comparable. Technical success rates were 95% (59 of 62) for thrombectomy and 90% (52 of 58) for thrombolysis (P: =.31). Clinical success rates were 89% (55 of 62) and 81% (47 of 58), respectively (P: =.24). At 30 days, 69% (43 of 62) and 66% (38 of 58), respectively, could be dialyzed through the graft (P: =.70); at 90 days, the rates were 40% (25 of 62) and 41% (24 of 58), respectively (P: =.91). None of these differences or those for procedure-related blood loss and early and late complications were statistically significant. Thrombus treatment times of 16.8 minutes for thrombectomy and 23.4 minutes for thrombolysis were significantly different (P:.01).The hydrodynamic thrombectomy system is at least as efficacious and safe as pulse-spray thrombolysis but shortens thrombus treatment time.

MTCs were magnetically targeted and retained at a region of interest in a swine model after intra-arterial infusion. MTCs did not redistribute after removal of the magnetic field. Histopathology results demonstrated high particle density in the area of the magnetic field. Particles were observed in the interstitium and occasionally intra-arterially. Regional delivery of chemotherapeutic drugs will be tested with this technology.

SummaryArterial embolisation has been used for >20 years to control acute haemorrhage secondary to obstetric and gynaecologic disease The use of this technique to specifically address pelvic haemorrhage in three major categories has increased in recent years. Embolisation is used to control acute pelvic haemorrhage in post-partum bleeding, postoperative bleeding and trauma, with success rates > 95% Early consultation with the interventional radiologist and modern angiographic equipment are key factors in achieving successful embolotherapy Uterine artery embolisation (UAE) is increasingly used to treat symptomatic uterine fibroids in women who wish to retain their uterus Careful pre-procedural evaluation is paramount Complications are uncommon and 8590% of women report significant improvement of symptoms. Complex pelvic masses, such as ectopic pregnancies, arteriovenous malformations (AVM) and cancer-related haemorrhage are also amenable to embolotherapy Post-embolisation symptom recurrence is frequent in ...

The first reported cases of uterine artery embolization in obstetric and gynaecological practice were carried out in the late 1970s. Recently, bilateral uterine artery embolization was used as a primary treatment for fibroids. Meticulous preoperative assessment is essential. The technique of uterine artery embolization involves the catheterization of both uterine arteries and the installation of tiny micro particles of polyvinyl alcohol. Following the procedure, post-procedural pain occurs within the first 24 h and most patients are advised to rest for 1 week. In the UCLA and RSCH series, three infective complications occurred leading to hysterectomy and some patients developed amenorrhoea. Average shrinkage of fibroids in the UCLA, RSCH and French series were 40%, 64% and 70%, respectively, with most patients losing their symptoms and being satisfied with the procedure. Meticulous pre-operative assessment is essential. At UCLA, 140 patients, and at RSCH, 96 patients have been embolized. To date in the UK, US and French series, fibroid growth has been arrested and new fibroids have not formed. However, long-term follow-up on a larger number of cases will be required before the role of uterine artery embolization in the gynaecologic therapeutic armamentarium can be fully defined.

SummaryEmbolisation of the uterine arteries, used for many types of pelvic haemorrhage, recently has been successfully applied to women suffering from myomata uterus. As a side effect of embolisation, myomata shrink more than 50% of their pre-embolisation size, measured by ultrasound. The embolised uterus has not been described elsewhere. Various clinical conditions gave rise to the possibility of viewing the effect of embolisation upon the uterus. Pathologic effects of embolisation of uterine arteries for control of menorrhagia associated with myomata are described, immediately and several months after the procedure.

SummaryWe evaluated the efficacy of transcatheter embolisation of the uterine arteries for the control of haemorrhage associated with myomata. Clinical follow-up, size of uterus and individual myomata on ultrasound, chart review for readmission and questionnaire administered by telephone formed the data-base for 25 embolisation patients. All patients who underwent bilateral embolisation reported relief of menorrhagia. Patients also noted relief of pelvic pain and pressure. Ultrasound showed diminution of total uterine volume of 46% and shrinkage of largest myoma of 37%. Failure that led to hysterectomy occurred in one patient; one patient suffered endometritis post-procedure and required hysterectomy. Readmission for fever and gastrointestinal complaints occurred in three patients. Most patients complained of post-procedure pain which was managed on an out-patient basis. Embolisation of myomata may offer patients an alternative to hysterectomy that is less morbid. This preliminary report requires further ...

Healthcare expenditure in many developed countries has reached such an unprecedented level that it cannot be sustainable unless some change in medical practice is implemented. In this paper, we examine a computer-in-the-loop model for the transaction between care-providers and care-receivers by identifying tasks that can be offloaded from physicians to computers in light of the state of the art of computer technology, as well as its evolution with time. Currently a number of consumer electronics innovations have found their way into healthcare applications. We anticipate that healthcare will be continuously benefited by such a trend.

DESCRIPTION OF THE PROBLEM One would be hard pressed to debate radiology’s important and dynamic role in health care. Although the field of radiology will continue to shine thanks to advances in technology and research, the future of radiologists is less certain. Declining reimbursements, longer hours, and busier shifts are the new norm and are likely here to stay, if not get worse. Although we have all felt the impact of these changes, they pale in comparison with the real problem of commoditization. Commoditization is a sobering reality that has led to new questions. What matters more: the radiologist or the radiology report? Is the radiologist simply a name on a report, without a face or identity? Has the radiology report become equivalent to a complete blood count in the clinician’s eyes? These questions, which may seem flippant, pose real dangers that need to be faced. A major factor that has propelled the commoditization frenzy is simply the lack of communication between radiologists and clinicians [1]. In the PACS era, clinicians more readily interpret their own studies [2]. Meanwhile, radiologists have decreased their education to clinicians on image interpretation, appropriateness, and the effects of radiation [2]. Whether it has been naivete or neglect, radiologists have not ameliorated the issue but continued with their de facto response: generate more relative value units. This pervasive apathetic approach to the problem, and failure to focus on a “service first” mentality, propels commoditization and is often the root cause of losing a hospital contract [3,4]. If radiologists are not ingrained during their training to be helpful consultants, they may learn when it is already too late.

UTERINE artery embolization (UAE) is a therapy that offers an alternative to traditional surgical procedures such as myomectomy and hysterectomy for women with symptomatic leiomyomata (fibroids). The clinical experience and the published literature indicate that this is an effective and safe therapy (1–9). For patients to receive the best possible care before, during, and after the embolization procedure, the Society of Interventional Radiology Task Force on Uterine Fibroid Embolization has developed this consensus statement to define the appropriate qualifications for physicians practicing in this field.

Uterine fibroids are a common problem in women. Statistics showing 20–50% of fibroids produce symptoms and consequently patients seek surgical intervention to improve their quality of life. Treatments for fibroids are typically successful in controlling the fibroid disease, yet sexual function following invasive surgical treatments for fibroids can be jeopardized. The Sexual Function Index (FSFI) is a valid instrument producing quantifiable reproducible results. In this paper three case reports are evaluated by the FSFI and compared between the following treatment groups: hysterectomy, myomectomy, and uterine embolization. Our goal is to illustrate how each of these treatment outcomes can result in sexual dysfunction and therefore decreased quality of life. Effects of invasive fibroid treatments on sexual functioning would be helpful in guiding patient’s ultimate decisions regarding treatment.

Cholecystectomy remains one of the most commonly performed procedures in general surgery. Although the incidence, diagnosis, and treatment of bile duct (BD) injuries have been well described, studies characterizing associated vascular injuries are limited. The objective of this study was to analyze the frequency and management of associated vascular and BD injury after cholecystectomy. A total of 50 patients were referred to a tertiary institution for BD injuries from 1996 to 2010. Thirty-nine (78%) of the patients were female with the mean age of 49 years (range, 14 to 86 years). Seventy-five per cent of the injuries were Strasberg Type E. Nine patients (18%) had associated vascular injuries. Six patients had injuries to the right hepatic artery; in one patient, both the right and left hepatic arteries were damaged. Five patients had right portal vein injuries; three of these subsequently died. In conclusion, as a result of the high incidence of associated vascular injury, a thin-collimation CT angiogram and/or mesenteric angiogram with portal venous imaging should be considered as part of the preoperative evaluation in patients with BD injury.

This credentialing document pertains to maintenance of noncoronary per-cutaneous interventional procedures privileges in the hospital setting. Safeand efficacious delivery of these services requires proficiency in theperformance of image-guided interventions. The education, experience,and skills required to perform image-guided interventions are extensive.Many interventional radiologists have demonstrated adequate training andeducation to provide these services by obtaining Subspecialty Certificationin Vascular and Interventional Radiology from the American Board ofRadiology.TheSocietyofInterventionalRadiology(SIR)believesthattheglobal skill set of those practitioners who have obtained and maintain thiscertificate be considered strongly for maintenance of privileges for image-guided interventions. Specifically, those who have achieved and maintainthat certificate should be considered qualified unless there is specificevidence in terms of outcomes of procedures that indicates competency islacking.

Purpose Lower-extremity endovascular interventions are increasingly being performed by vascular surgeons (VSs) and interventional cardiologists (ICs) in addition to interventional radiologists (IRs). Regardless of specialty, well trained, experienced, and dedicated operators are expected to offer the best outcomes. To examine specialty-specific trends, outcomes of percutaneous lower-extremity revascularizations in Medicare beneficiaries were compared according to physician specialty types providing the service. Materials and Methods Medicare Standard Analytical Files that contain longitudinal data of all services (physician, inpatient, outpatient) provided to a 5% sample of Medicare beneficiaries were studied. All claims for percutaneous angioplasty, atherectomy, and stent implantation of lower-extremity arteries during the years 2005–2007 were extracted, and the following outcomes were assessed: mortality, transfusion, intensive care unit (ICU) use, length of stay, and subsequent revascularization or amputation. Outcomes were compared by using regression models adjusted for age, sex, race, emergency department admission, and comorbid conditions. Results Most outcomes were significantly worse if the service was provided by vascular surgeons compared with other vascular specialists. The in-hospital mortality rate for procedures performed by VSs was 19% higher than for those performed by others, but this difference was not significant ( P =.351). Adjusted average 1-year procedure costs were significantly lower for IRs ($17,640) than for VSs ($19,012) or ICs ($19,096). Conclusions Medicare data show that endovascular lower-extremity revascularization by vascular surgeons results in more transfusion and ICU use, longer hospital stay, more repeat revascularization procedures or amputations, and higher costs compared with procedures performed by interventional radiologists.

The Society of Interventional Radiology (SIR) continues to work for its members and is navigating a path to success for our specialty during this time of changes in the national health care environment. In response to nationally mandated expectations of improved quality at lower cost, SIR has pursued multiple pathways to help ensure the future success of interventional radiology (IR). SIR is collaborating with colleagues from other specialties to prevent or limit payment rate reductions. SIR remains an active participant in the national Current Procedural Terminology coding process and the accompanying code valuation, which takes place as part of American Medical Association Relative Value Scale Update Committee activities. We have invested hundreds of volunteer hours and staff resources in ensuring that our coding and valuation strategy is grounded on sound data driven by what is optimal for patient care. We have worked long and hard, and we have been able to preserve excellent value for IR treatments. SIR and the SIR Foundation have carefully examined various activities to ensure that they are consistent with our strategic goals, with an eye on ensuring that the Society’s and the Foundation’s pursuits are fully aligned. The Society established the Payment, Research and Policy (or PReP) Task Force to identify and prioritize data development and research needs to improve patient care in the long term and to help lead to a more efficient reimbursement system. Task force members are working

To describe registry methods and baseline patient demographics from a national sample of women undergoing uterine artery embolization for uterine leiomyomata.Interventional radiology practices were recruited to submit data by a secure Web site on women undergoing uterine artery embolization for symptomatic leiomyomata. Baseline data included patient demographics, prior medical, surgical, and obstetrical history, uterine anatomy, and quality-of-life measures. Subsequent data collected included details of the uterine artery embolization procedure and hospital stay and outcomes at 30 days; patients were also offered the opportunity to participate in longer-term follow-up. Characteristics of white and African-American women were compared using t tests, chi(2), or Wilcoxon rank-sum tests as appropriate.As of December 31, 2002, 3,319 uterine artery embolization cases had been entered into the registry by 72 sites; number of patients entered by individual sites ranged from 1 to 514. Of these patients, 95.4% consented to participation in the short-term outcomes registry. Forty-eight percent of patients were African American, and 44.4% were white and non-Hispanic. Heavy menstrual bleeding was the single most bothersome symptom in 64.3% of patients. Compared with white non-Hispanic women, African-American women were significantly younger, more likely to be obese, had larger uteri and more numerous leiomyomata, more severe symptoms, and poorer quality-of-life scores before treatment.It is feasible to collect prospective data on new technologies. The FIBROID Registry prospectively collected data on more than 3,000 women undergoing uterine artery embolization for symptomatic leiomyomata. Baseline patient characteristics of this patient population seem to be similar to those of women undergoing other procedures for leiomyomata.III.

SummaryTwo patients of an initial pilot study are reported. Both suffered from menorrhagia associated with uterine myomata. In each case bilateral uterine artery embolization under digital subtraction angiography was performed using polyvinyl alcohol particles. Patients' anaemia improved; follow-up ultrasound showed a reduction of both uterine volumes and size of myomata. No side-effects from the procedure were noted.

The objective of this study was to evaluate the efficacy of heparin-polymer-coated intravascular stents in the reduction of vessel stenosis. Three types of coatings for Palmaz stents were tested: 1) heparin covalently bound to a polyethylene oxide (Hp-PEO) tether; 2) heparin copolymerized with ethylene vinyl acetate (Hp-Elvax) and 3) Elvax alone. Polymer-coated stents and uncoated controls were deployed in the external iliac arteries following endothelial injury in 18 swine. The animals were maintained on an atherogenic diet and examined by angiography at 6 and 12 weeks. The stented segments were then harvested for histopathologic analysis. Both types of heparin-coated stents resulted in increased luminal narrowing as compared to the contralateral uncoated stents. At 6 weeks, average luminal stenosis was 48% for Hp-PEO stents vs 35% for uncoated stents (p < 0.05). At 12 weeks, average luminal stenosis was 36% for Hp-PEO stents vs 26% for uncoated stents (p = NS). For Hp-Elvax stents, the average stenosis was 58% vs 33% for uncoated controls (p < 0.05) at 6 weeks and 47% vs 19% for uncoated controls (p < 0.05) at 12 weeks. There was no significant difference between Hp-Elvax stents and Elvax stents (p = NS). Increased luminal narrowing in coated stents was primarily secondary to a marked inflammatory response. Heparin-polyethylene oxide and heparin-ethylene vinyl acetate-coated stents resulted in increased luminal narrowing as compared with uncoated stents, due to a marked inflammatory response.